<p> Affiliate Membership The Japanese Headache Society</p><p>Online-only membership  Online subscription to Cephalalgia, published 16 times per year  Online access to Cephalalgia and The Neuroscientist via the IHS website  Access to the Online Learning Centre and the members’ pages of the IHS website  Entitlement to apply for IHS Fellowships  Early access to IHS guidelines and other publications  Reduced registration to biennial International Headache Congress (Berlin, June 2011)  Voting rights and eligibility to sit on IHS committees Membership application - declaration must be completed by all applicants:</p><p>Please accept my application for membership, and in the event of being accepted I hereby consent to membership in IHS and will abide by the Memorandum and Articles of Association. I certify that I am professionally engaged or interested in headache or related fields. I agree to the Company's request to send or supply documents and information to me in electronic form.</p><p>Preferred website Username: ______Preferred website Password: ______(to enable access to the members area (including Cephalalgia and Learning Centre) of the IHS website)</p><p>Name in capitals and signature of applicant</p><p>______(Name in capitals) (Signature)</p><p>Address ______</p><p>______</p><p>Telephone: ______Fax: ______</p><p>E-mail: ______</p><p>Specialty: ______Purely clinical/Basic research/Clinical research (delete as appropriate)</p><p>To keep our costs low, most of our communication is now done by email. Please ensure you provide an email address.</p><p>Affiliate Society</p><p>I confirm I am a member of the Japanese Headache Society, an Affiliate Member Society of the International Headache Society.</p><p>Method of payment Membership is on a calendar-year basis. Membership fees for 2011: Full membership: US$ 220; € 165; £ 140 Online-only membership: US$ 120; €90; £75, Clinical trainee/full-time student: US$65; €50; £40</p><p>Please charge my: VISA Eurocard/Mastercard AmEx US$ € £ (please tick)</p><p>Card no: ______Expiry date: ______</p><p>Name (as on card): ______</p><p>Signature: ______</p><p>Your contact details will be included in our website members directory which is available ONLY to other IHS members. If you do not wish to be included please tick here . In the normal course of business, your details may be shared with IHS' associates. Please tick this box if you do not consent to this . Send to: International Headache Society, 41 Welbeck Street, London W1G 8EA UK. E-mail: [email protected]; Fax: +44 207 504 8788</p>